Provider Demographics
NPI:1558570853
Name:REYESMARTINEZ, JOSE MARIA (PA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARIA
Last Name:REYESMARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 NW 8TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2836
Mailing Address - Country:US
Mailing Address - Phone:786-712-4499
Mailing Address - Fax:786-845-9398
Practice Address - Street 1:8085 NW 8TH ST APT 9
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2836
Practice Address - Country:US
Practice Address - Phone:786-712-4499
Practice Address - Fax:786-845-9398
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9100871OtherPHYSICIAN ASSISTANT